Profile — Quality assurance: Charlene Harrington, Professor, University of California-San Francisco

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Few in the nursing home community seem to particularly like Charlene Harrington. And, quite frankly, it's easy to see why.

A longtime critic of the nursing home industry, Harrington rarely bestows a complimentary word on the field.
And after serving 30 years as a thorn in their side, she is unbowed. Why?
"Because it's for the right reasons," she explains.
Whether or not one agrees with Harrington, it's hard to dispute her passion, or her expertise. She served on the Institute of Medicine committee whose recommendations led to the landmark Omnibus Budget Reconciliation Act of 1987. Most recently, she offered a sobering 20th anniversary OBRA assessment at a Senate Special Committee on Aging hearing in May.
"Even though some nursing homes offer high quality of care, the persistent quality problems continue to shock and dismay us," she told the committee.
As a respected government researcher and close friend of the National Citizens' Coalition for Nursing Home Reform (NCCNHR), Harrington forcefully campaigns for staffing mandates – namely, a minimum of 4.1 nursing hours per resident day.
"She's made a big difference in people's understanding of nursing home quality," says Janet Wells, director of public policy for NCCNHR.
Others see it differently.
"She sits on the sidelines with her bow and arrow. It's frustrating," says Betsy Hite, director of public affairs for the California Association of Health Facilities. California providers have been the subject of several Harrington-led studies.
Harrington believes nursing homes are responsible for their own bad image.
"If they were serious about quality, they would do something about staffing and turnover, and until they do that, I don't think they're serious," she says.
Her take on the industry's quality initiatives are no gentler: They are merely a public relations effort, she says. And the wave of culture change initiatives such as the Eden Alternative? The same, unfortunately.
"You cannot sustain culture change without adequate staffing and so, again, some of those efforts are primarily public relations efforts rather than real change efforts," she says staunchly.
But Harrington is not all pessimistic. In fact, she believes better times are ahead as a result of the baby boomers, who will demand higher standards of care.
She also feels strongly that her recommendations to the Senate Aging Committee – on staff reporting requirements and cost centers – could lead to big improvements.
A professor at the University of California-San Francisco, Harrington is passionate about research. She received a Ph.D. in sociology and higher education from the University of California-Berkeley before working for the California State Department of Health in 1975. After writing a report on the state's regulatory system, she was asked to head the system.
It may surprise some that this pedigreed professional attended a one-room schoolhouse as a child. She grew up on a farm in Concordia, KS, with "a sister, cousins and lots of animals." Her mother was a grade school teacher and her father was a farmer. She wanted to do something different, so she became a nurse. She held several nursing posts after earning her RN degree.
Her life today is packed between teaching and research duties at UCSF, and advocacy. She often travels cross-country to the nation's capital to advocate for public policy changes.
When not working, she usually is visiting her husband at Salem Lutheran, a residential care facility in Oakland, CA. He suffers from advanced dementia.
Despite her busy life, the 65-year-old says she has no plans to stop poking and prodding the industry. In fact, she says she in two years intends to abandon teaching and devote all her efforts to advocacy and research.
She says she's still hopeful about quality improvements.
"It's just taken an awfully long time, but I think demographics are on our side and consumer organizations are getting more vocal about it. I don't want to work on anything else."

Harrington's Resume
1963 - Receives B.S., R.N. degree in nursing from the University of Kansas-Lawrence
1965 - Works as director of nursing for U.S. Army Dependent Schools, Heilbronn, Germany
1975 - Receives Ph.D. from the University of California-Berkeley
1976 - Serves as deputy director of the Division of Licensing and Certification, California State Department of Health
1986 - Acts as member of IOM committee whose report on quality issues in nursing homes leads to OBRA of 1987
1989 - Becomes professor of the Department of Social and Behavioral Sciences, UCSF